Stats show private insurers deny fewer claims than Medicare

Washington Examiner ^ | 12/4/09 | MARK HEMINGWAY

[FromLori]

Speaking on the Senate floor today, Sen. Chris "Where's the mortgage paperwork?" Dodd, D-Conn., was telling another sob story about someone being denied treatment by a private insurer. This supposedly demonstrates the need for government run insurance. "That would not have happened under Medicare. Had she been just under Medicare, she would have gotten that help, no questions asked," said Dodd.

But is it really easier to get medical treatment under Medicare than private insurance? The idea that government-run health care would deny fewer claims than private insurers callously concerned about maximizing profits is an article of faith among Democrats. It also happens to be a total myth.

In fact, according to the American Medical Association's 2008 National Health Insurer Report Card, "Medicare Denied 6.85% Of Submitted Claims – A Higher Percentage Than Any Private Insurer Sampled By The American Medical Association." Oh and when a private insurance company denies your claim, you at least have legal recourse. Good luck suing the government.

As for whether Medicare gives help to people "no questions asked" -- Medicare should ask a lot more questions about the claims they do pay out. Even the White House admits over 12 percent of Medicare claims are fraudulent. So Medicare denies more claims than private insurance, and of the ones they do accept, 1 in 8 are fraudulent or improper. By some estimates, Medicare loses seven times as much money in fraud every year than the combined profits of the 14 health insurance companies on the Fortune 500.

If congressional Democrats weren't constantly telling me they know better, I'd say it sure looks like profit-driven insurance companies are more efficient and fair -- than government run health care.

[kittymyrib]

When my husband’s $6,500 operation was reimbursed by Medicare for $2,100, I could understand why many doctors are no longer taking Medicare patients. I wouldn’t either.

[thackney]

BTTT

[Cyman]

I don’t know where or how the AMA got their statistics but my MediCare claims rejection rate is way under 1%, way under.The one nice thing[and only] that I Can say about MediCare is that generally their claims processing system is darn quick and reasonably accurate. I wish all of my claims were paid in 14 days.

[Androcles]

Lazy article which isn’t compairing apples and apples. Folk on a private scheme are statistically more likkely to be earning more and better educated/experienced. The number of stupid claims is likely to be lower, as is the number of visibly duplicitous claims.

The Medicare ones on the other hand include all the great unwashed and folk who’ll try anything on.

There is a nugget to be explored in this article but the author was too lazy to do any real analysis and make it worthwhile rerading. Or, he may have done so and then found the analysis results were less interesting and sensational.

[LurkedLongEnough]

Another perspective on fraud - working at a large private health insurer, my friend says they all had to take mandatory training on detecting fraud, and have recovered over $6 million on just one of the claim fraud lawsuits they’ve been investigating.

One of the biggest frauds around who played the system for self-gain - Chris Dodd - the ‘model’ government worker. Multiply him by the thousands and that will be your new insurance company, which will operate just like Fannie & Freddie.